Nur 473: primary health care nursing

Foundations of Community
Health Nursing

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Chapter One
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Opportunities and Challenges of
Community Health Nursing
What is Community Health
Nursing
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Objectives

After completion the lecture the students enable to:

•Define community health and distinguish from public health
•Explain the concept of the community
•Describe three types of communities
•Diagram the health continuum
•Differentiate among the three levels of prevention
•Analyze the six components of community health practice
•Describe the eight characteristics of community health nursing
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To understands what is the
community health nursing

Nursing 473: primary health nursing – lecture 1 4

We should answer these questions

•What are the goals of the community

health nursing (CHN)
•Who is the client of the CHN
•What are the setting of the CHN
•What are the salient role provided by
CHN
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Introduction
The communities in which we live and work
have a profound influence on our collective
health and well-being. (Example: both smoking
and passive exposure to tobacco smoke are
directly associated with serious negative health
effects )
the health of a community is more than the
sum of the health of its individual citizens.
Community health, as a field of practice,
seeks to provide organizational structure, a
broad set of resources, and the collaborative
activities needed to accomplish the goal of an
optimally healthy community. 6
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Introduction
In acute care, the health of an individual is the
primary focus. Community health broadens that focus
to concentrate on families, populations, and the
community at large. The community becomes the
recipient of service, and health becomes the product.
Although many believe that health and illness are
individual issues, evidence indicates that they also are
community issues. The spread of the HIV pandemic,
nationally and internationally, is a dramatic and tragic
case in point

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Introduction
Communities can influence the spread of disease,
provide barriers to protect members from health
hazards, organize ways to combat outbreaks of
infectious disease, and promote practices that
contribute to individual and collective health.
Many different professionals work in community health
to form a complex team
The city planner designing
The social worker
The physician
And other

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Introduction
The professional nurse is an integral member of this
team, a linchpin and a liaison between physicians, social
workers, government officials, and law enforcement
officers. Community health nurses work in every
conceivable kind of community agency, from a state
public health department to a community-based
advocacy group.

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Introduction
Their duties range from examining infants in a well-
baby clinic, or teaching elderly stroke victims in their
homes, to carrying out epidemiologic research or
engaging in health policy analysis and decision making.
Despite its breadth, however, community health
nursing is a specialized practice. It combines all of the
basic elements of professional clinical nursing with public
health and community practice.

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Introduction
Community health and public health share many features.
Both are organized community efforts aimed at the
promotion, protection, and preservation of the public’s
health.
Historically, as a field of practice, public health has been
associated primarily with the efforts of official or
government entities—for example, federal, state, or local
tax supported health agencies that target the whole range
of health issues.
In contrast, private health efforts, such as those of the
American Lung Association or the American Cancer
Society, work toward solving selected health problems.
The latter augments the former. Currently, public health
practice encompasses both approaches and works
collaboratively with all health agencies and efforts, public 11
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THE CONCEPT OF COMMUNITY

 A community is a collection of people who share some
important feature of their lives.
 A collection of people who interact with one another and
whose common interests or characteristics form the basis
for a sense of unity or belonging.
•It can be a society of people holding common rights and
privileges (eg, citizens of a town),
•sharing common interests (eg, a community of farmers),
•living under the same laws and regulations (eg, a prison
community).
The function of any community includes its members’
collective sense of belonging and their shared identity,
values, norms, communication, and common interests and
concerns
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Geographic Community
A community often is defined by its geographic
boundaries and thus is called a geographic community. A
city, town, or neighborhood is a geographic community.
(Consider the community of Gaza city)
In community health, it is useful to identify a
geographic area as a community
 a community demarcated by geographic boundries,
such as city or county, become clear target for analysis
health needs
Available data, morbidity mortality and population
density can augment assessment studies to form the
basis for planning health programs

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Geographic Community
media campaigns and other health education efforts
can readily intended audiences. Example :
Distribution educational information on the danger of
smoking, importance's of breast feeding, risk factor
for diabetes and hypertension and the danger of
substance abuse

 a geographic community is easily mobilized for action.

Groups can be formed to carry out intervention and
prevention efforts that address needs specific to that
community

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Common-Interest Community
A community also can be identified by a common
interest or goal. A collection of people, even if they
are widely scattered geographically, can have an
interest or goal that binds the members together.
Example
the members of a national professional organization
women who have had mastectomies are all common-
interest
communities.

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Community of Solution
A type of community encountered frequently in community
health practice is a group of people who come together to
solve a problem that affects all of them. The shape of this
community varies with the nature of the problem, the size
of the geographic area affected, and the number of
resources needed to address the problem. Such a
community has been called a community of solution.
Example
a water pollution problem may involve several counties
whose agencies and personnel must work together to
control upstream water supply, industrial waste disposal,
and city water treatment

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Populations and Aggregates

population refers to all of the people occupying an
area, or to all of those who share one or population
may more characteristics.
In contrast to the community, a population is made up of
people who don’t necessarily interact with one anther and
don’t necessarily share a sense of belonging to that group
A population may be defined geographically, such as the
population of the United States or a city’s population. This
designation of a population is useful in community health
for epidemiologic study and for collecting demographic
data for purposes such as health planning.
A population also may be defined by common qualities or
characteristics, the common characteristic might be any
thing that thought to relate to health such as age, sex,
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race, social class etc
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Populations and Aggregates

Aggregate; are people who don’t have the relatedness
necessary to constitute an interpersonal group buy who
have one or more characteristics in common
Example:
Aggregate can be identified by virtue of
setting( those enrolled in a well-baby clinic
Demographic characteristics ( women)
Health status ( smokers, hypertension)

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Risk
Risk: the probability that a disease or other
unfavorable health condition will develop

At risk-population:
Epidemiologic information is used to identify populations
at higher risk for specific preventable health conditions

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THE CONCEPT OF HEALTH

“a state of complete physical, mental, and social well-
being and not merely the absence of disease or infirmity”

Wellness: Is the process of moving towered

integrating human functioning and maximizing potential.

Wellness, includes the definition of health incorporates

the capacity to develop one's potential to lead fulfilling
and productive life; can be measured in terms of quality of
life.

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THE CONCEPT OF HEALTH

They also are the beginning to understand the relationship
. .of health to environment
Wellness is the ability to adapt, to relate effectively, and -
-:to function at near-maximum capacity and includes
.Self-responsibility -
.Nutritional awareness -
.Physical fitness -
.Stress management -
.Environmental sensitivity -
.Productivity -
.Expression of emotion -
.Creativity -
.Personal care -
- Home safety.
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Well-being: a state of positive health or a person's

perception concerning positive health.

Influences on Health
:Many factors, influence the health including
.Lifestyle -
.Genetics -
-The environment.

-Florence Nightingale, explored the health and illness

connection with the environment. She believed that a
person's health was greatly influenced by ventilation,
noise, light, cleanliness, diet, and restful bed.
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The Health Continuum: Wellness–Illness

Society suggests a polarized or “either/or” way of
thinking about health: people either are well or they are ill.
Yet wellness is a relative concept, not an absolute, and
illness is a state of being relatively unhealthy. There are
many levels and degrees of wellness and illness, Because
health involves a range of degrees from optimal health at
one end to total disability or death at other, it often
describes as a continuum.
:It range from
High level wellness.(Optimal Health) -
.Good health -
.Normal health -
.Illness -
.Critical illness -
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- Total disability or Death.
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The Health Continuum: Wellness–Illness

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The Health Continuum: Wellness–Illness

This health continuum applies not only to individuals but
also to families and communities. A nurse might speak of a
dysfunctional family, meaning one that is experiencing a
relative degree of illness; or a healthy family might be
described as one that exhibits many wellness
characteristics, such as effective communication and
conflict resolution, as well as the ability to work together
and use resources appropriately. Likewise, a community, as
a collection of people, may be described in terms of
degrees of wellness or illness. The health of an individual,
family, group, or community moves back and forth along
this continuum throughout life.

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The Health Continuum: Wellness–Illness

A healthy community, first described by Cottrell (1976) as
a competent community, is one in which the various
organizations, groups, and aggregates of people making up
the community do at least four things:
1. They collaborate effectively in identifying the problems
and needs of the community.
2. They achieve a working consensus on goals and priorities.
3. They agree on ways and means to implement the agreed
on goals.
4. They collaborate effectively in the required action.

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The Health Continuum: Wellness–Illness

Community health practice ranges over the entire
continuum; it always works to improve the degree of
health in individuals, families, groups, and communities.
In particular, community health practice emphasizes the
promotion and preservation of wellness and the
prevention of illness or disability..

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Health as a State of Being

Health refers to a state of being, including many different
qualities and characteristics. An individual might be described in terms
such as energetic, outgoing, enthusiastic, beautiful, caring, loving, and
intense. Together, these qualities become the essence of a person’s
existence; they describe a state of being. Similarly, a specific
geographic community, such as a neighborhood, has many
characteristics. It might be characterized by the terms congested,
deteriorating, unattractive, dirty, and disorganized. These
characteristics suggest diminishing degrees of vitality
Health balance
Is a state of well-being that results from healthy interaction
between a person’s body , mind, spirit and environment
individuals want to avoid illness and its consequences.

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Health as a State of Being

Health involves the total person or community. All of the
dimensions of life affecting everyday functioning
determine an individual’s or a community’s health, including
physical, psychological, spiritual, economic, and
sociocultural experiences. All of these factors must be
considered when dealing with the health of an individual or
community. The approach should be holistic. A client’s
placement on the health continuum can be known only if the
nurse considers all facets of the client’s life, including not
only physical status but also the status of home, family,
and work.

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Subjective and Objective Dimensions of Health

Health involves both subjective and objective dimensions;
that is, it involves both how people feel (subjective) and
how well they can function in their environment (objective).
Healthy people are full of life and vigor, capable of hysical
and mental productivity. They feel minimal discomfort and
displeasure with the world around them. Again, people
experience varying degrees of vitality and well-being.
Health also involves the objective dimension of ability to
function. A healthy individual or community carries out
necessary activities and achieves enriching goals. unhealthy
people not only feel ill but are limited, to some degree, in
their ability to carry out daily activities. Indeed, levels of
illness or wellness are measured largely in terms of ability
to function (Roach, 2000)
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Subjective and Objective Dimensions of Health

The subjective dimension (feeling well or ill) and the
objective dimension (functioning) together provide a
clearer picture of people’s health. When they feel well and
demonstrate functional ability, they are close to the
wellness end of the health continuum. Even those with a
disease such as arthritis or diabetes may feel well and
perform well within their capacity. These people can be
considered healthy or closer to the wellness end of the
continuum. Figure 1–3 depicts the relationships between
the subjective and objective views of health.

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Definition
Community health is the identification of needs and the
protection and improvement of collective health within a
geographically defined area.
ANA definition:
CHN is a synthesis of nursing practice and public health
practice applied to promoting and preserving the health
of populations. The practice is general and
comprehensive. It continuing not episodic. The dominant
responsibility is to population as a whole, nursing
directed to individuals, families or group contributes to
the total population … the focus of CHN is on the
prevention of illness and the promotion and maintenance
of health
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Definition
Public health is the science and art of preventing disease,
prolonging life, and promoting health and efficiency
through organized community efforts for the sanitation of
the environment, the control of communicable infections,
the education of the individual in personal hygiene, the
organization of medical and nursing services for the early
diagnosis and preventive treatment of disease, and the
development of the social machinery to insure everyone a
standard of living adequate for the maintenance of health,
so organizing these benefits as to enable every citizen to
realize his birthright of health and longevity

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Definition
One of the challenges community health practice faces
is to remain responsive to the community’s health needs.
As a result, its structure is complex; numerous health
services and programs are currently available or will be
developed. Examples include health education, family
planning, accident prevention, environmental protection,
immunization, nutrition, early periodic screening and
developmental testing, school programs, mental health
services, occupational health programs, and the care of
vulnerable populations.

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Major goals for community health nursing

1.Care of ill, disabled and suffering
2.Support development and well-being throughout the
lifecycle
3.Promotion of human relatedness and mutual caring
4.Promotion of self responsibility regarding health and
well-being
5.Promotion of relative safety in the environment while
conversing resources

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COMPONENTS OF COMMUNITY HEALTH PRACTICE

Mission of the CHN

These components are

(1)Promotion of health,
(2)prevention of health problems,
(3)treatment of disorders,
(4) rehabilitation,
(5) evaluation, and
(6) research

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COMPONENTS OF COMMUNITY HEALTH PRACTICE

(1) Promotion of health
Definition:
1. action related to lifestyles and choices that maintain
or enhance a populations health (WHO)
2. "Any combination of educational, organizational, economic,
and environmental supports for behavior and conditions of
living conductive to health".

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COMPONENTS OF COMMUNITY HEALTH PRACTICE

(1) Promotion of health
Promotion of health is recognized as one of the most
important components of public health and community
health
practice
Health promotion includes all efforts
that seek to move people closer to optimal well-being
or higher levels of wellness. Nursing, in particular, has a social
mandate for engaging in health promotion
Health promotion programs and activities include
many forms of health education—for example, teaching the
dangers of drug use, demonstrating healthful practices such
as regular exercise, and providing more health-promoting
options such as heart-healthy menu selections.
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COMPONENTS OF COMMUNITY HEALTH PRACTICE

(1) Promotion of health
Community health promotion, then, encompasses the
development and management of preventive health care
services that are responsive to community health needs.
Wellness programs in schools and industry are examples;
they are useful when they are accompanied by desire,
opportunity, and resources that encourage more healthful
practices.

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COMPONENTS OF COMMUNITY HEALTH PRACTICE

Health promotion programs and activities includes many forms
-:of health education- for example
.Physical activity and fitness -
.Nutrition -
.Tobacco use -
.Teaching the dangers of alcohol and drug use -
.Family planning -
.Mental health and mental disorders -
.Violent and abusive behavior -
- Educational and community-based programs.

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COMPONENTS OF COMMUNITY HEALTH PRACTICE

(1) Promotion of health
The goal of health promotion is to raise levels of wellness
for individuals, families, populations, and communities.
Community health efforts accomplish this goal through a
three-pronged effort to:
1. Increase the span of healthy life for all citizens
2. Reduce health disparities among population groups
3. Achieve access to preventive services for everyone

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COMPONENTS OF COMMUNITY HEALTH PRACTICE

(2) prevention of health problems
Prevention of health problems constitutes a major part of
community health practice. Prevention means anticipating
and averting problems or discovering them as early as
possible to minimize potential disability and impairment. It
is practiced on three levels in community health: (1)
primary prevention, (2) secondary prevention, and (3)
tertiary prevention(Neuman, 2001).

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COMPONENTS OF COMMUNITY HEALTH PRACTICE

(2) prevention of health problems
I. Primary Prevention: Any effort done before or to
prevent the problem to occur
II. Primary prevention obviates the occurrence of a health
problem; it includes measures taken to keep illness or
injuries from occurring. It is applied to a generally healthy
population and precedes disease or dysfunction.
Example
Genetic counseling
Immunization
Health diet and healthy lifestyle

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COMPONENTS OF COMMUNITY HEALTH PRACTICE

(2) prevention of health problems, primary prevention
Examples of
primary prevention activities by a community health nurse
include encouraging elderly people to install and use safety
devices (eg, grab bars by bathtubs, hand rails on steps), to
prevent injuries from falls; teaching young adults healthy
lifestyle behaviors so that they can adopt changes for a
lifetime, for themselves and their children; or working
through
a local health department to help control and prevent
communicable diseases such as rubeola, poliomyelitis, or
varicella by providing regular immunization programs.

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COMPONENTS OF COMMUNITY HEALTH PRACTICE

(2) prevention of health problems
II. secondary prevention
involves efforts to detect and treat existing health problems at
the earliest possible stage when disease or impairment
already exist. Hypertension and cholesterol screening
programs in many communities help to identify high-risk
individuals and encourage early treatment to prevent heart
attacks or stroke. Other examples are teaching breast and
testicular self-examination, encouraging regular
mammograms
and Pap smears for early detection of possible cancer, and
providing skin testing for tuberculosis (in infants at 1 year
of age and periodically throughout life, with increasing
frequency
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for high-risk groups).
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COMPONENTS OF COMMUNITY HEALTH PRACTICE

(2) prevention of health problems
II. secondary prevention
Secondary prevention attempts to discover a health problem
at a point when intervention may lead to its control or
eradication. This is the goal behind testing of water and soil
samples for contaminants and hazardous chemicals in the
field of community environmental health. It also prompts
community health nurses to watch for early signs of child
abuse in a family, emotional disturbances in a group of
widows, or alcohol and drug abuse among adolescents.

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COMPONENTS OF COMMUNITY HEALTH PRACTICE

(2) prevention of health problems
III. Tertiary Prevention
Tertiary prevention attempts to reduce the extent and
severity of a health problem to its lowest possible level, so as
to minimize disability and restore or preserve function.
Examples include treatment and rehabilitation of persons
after
a stroke to reduce impairment, postmastectomy exercise
programs to restore functioning, and early treatment and
management of diabetes to reduce problems or slow their
progress..

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COMPONENTS OF COMMUNITY HEALTH PRACTICE

(3) treatment of disorders
The third component of community health practice is treatment
of disorders. It focuses on the illness end of the continuum
and is the remedial aspect of community health practice.
This occurs by three methods:
(1) direct service to people with health problems, eg. home
visits, provides an educational program and support group
for people
wanting to stop smoking or lose weight
(2) indirect service that helps people to obtain treatment, and
(3) development of programs to correct unhealthy
conditions.

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COMPONENTS OF COMMUNITY HEALTH PRACTICE

(3) treatment of disorders
(2) indirect service that helps people to obtain treatment eg.
assisting people with health problems to obtain treatment.
A young woman with postpartum bleeding, assisted by the
community health nurse, can obtain an immediate
appointment with a physician at the local clinic.
(3) development of programs to correct unhealthy conditions
One community with a high incidence of alcoholism and drug
abuse initiated a chemical dependency counseling and
treatment center.

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COMPONENTS OF COMMUNITY HEALTH PRACTICE

(4) Rehabilitation
involves efforts to reduce disability and, as much as possible,
restore function.

(5) evaluation
is the process by which that practice is analyzed, judged,
and improved according to established goals and standards.
Evaluation of health and health care should be an integral
part of every kind of health service, from individual practice
to national and international programs.

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COMPONENTS OF COMMUNITY HEALTH PRACTICE

(6) Research
is systematic investigation to discover facts affecting
community health and community health practice, solve
problems, and explore improved methods of health service.
Community health practitioners conduct and use scientific
investigations at all levels, from federal agencies such as
the U. S. Public Health Service to state and local groups
conducting research. Epidemiology (the study of health
and disease determinants and distribution in populations)
and biostatistics (the science of statistically measuring
population
health conditions) are the primary public health measurement
and analytic sciences underlying community health practice.
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COMPONENTS OF COMMUNITY HEALTH PRACTICE

(6) What the deffrences between the health promation and
health protection
Individual in health protection want to avoid illness and
its consequences
.

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 goal of the community health nursing

Goals

Community health nursing preserves and

improves the health of population and
communities worldwide by meeting the
collective needs of the community and societies

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 CHARACTERISTICS OF COMMUNITY HEALTH NURSING

CHARACTERISTICS OF COMMUNITY HEALTH NURSING

Eight characteristics of community health nursing are
particularly salient to the practice of this specialty:
(1)it is a field of nursing;
(2)it combines public health with nursing;
(3)It is population focused;
(4) it emphasizes prevention, health promotion, and
wellness;
(5) it promotes client responsibility and self-care;
(6) it uses aggregate measurement and analysis;
(7) it uses principles of organizational theory; and
(8) it involves interprofessional collaboration..

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 CHARACTERISTICS OF COMMUNITY HEALTH NURSING ……. Cont.

(1) it is a field of nursing;

The two characteristics of any specialized nursing practice
are (1) specialized knowledge and skills, and (2) focus on a
particular set of people receiving the service. These two
characteristics are true for community health nursing. As a
specialty field of nursing, community health nursing adds
public health knowledge and skills that address the needs
and
problems of communities and aggregates and focuses care on
communities and vulnerable populations.

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 CHARACTERISTICS OF COMMUNITY HEALTH NURSING ……. Cont.

(2)it combines public health with nursing;

Community health nursing, then, as a field of nursing,
combines nursing science with public health science to
formulate a community-based and population-focused
practice
(Williams, 2000). It “synthesizes the knowledge from the
public health sciences and professional nursing theories”
(ANA, 1999, 2000) to improve the health of communities
and vulnerable populations.

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 CHARACTERISTICS OF COMMUNITY HEALTH NURSING ……. Cont.

Knowledge of the following elements of public health is essential to

community health nursing (ANA, 1999)
1. History and philosophy of public health, including emphasis
on the greatest good for the greatest number
2. Concept of aggregates—assessing needs, planning and providing
services, and evaluating services’ impact on population groups—
including aggregate-level decision-making
3. Priority of preventive, protective, and health-promoting
strategies over curative strategies
4. Means for measurement and analysis of community
health problems, including epidemiologic concepts and
biostatistics
5. Influence of environmental factors on aggregate health
6. Principles underlying management and organization for
community health, because the goal of public health is accomplished
through organized community efforts
7. Public policy analysis and development
8. Health advocacy and the political process
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 CHARACTERISTICS OF COMMUNITY HEALTH NURSING ……. Cont.

(3)It is population focused;

The central mission of public health practice is to improve
the health of population groups. Community health nursing
shares this essential feature: it is population focused,
meaning that it is concerned for the health status of
population groups and their environment.

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 CHARACTERISTICS OF COMMUNITY HEALTH NURSING ……. Cont.

(4) it emphasizes prevention, health promotion, and

wellness;
In community health nursing, the promotion of health and
prevention of illness are of first-order priority. There is less
emphasis on curative care.
These include services to mothers and infants, prevention
of environmental pollution, school health programs, senior
citizens’ fitness classes, and “workers’ right-to-know”
legislation that warns against hazards in the workplace.

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 CHARACTERISTICS OF COMMUNITY HEALTH NURSING ……. Cont.

(5) it promotes client responsibility and self-care;

The goal of public health, “to increase quality and years of
healthy life and eliminate health disparities” (UDHHS,
2000), requires a partnership effort.
Clients’ health status and health
behavior will not change unless people accept and apply the
proposals (developed in collaboration with clients) presented
by the community health nurse.

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 CHARACTERISTICS OF COMMUNITY HEALTH NURSING ……. Cont.

(5) it uses aggregate measurement and analysis;

Community health nursing uses aggregate measurement and
analysis. The need to collect and examine data on the entire
population under study before making intervention decisions
is fundamental to community health nursing in a public
health practice. Health states, environmental factors,
healthrelated services, economic patterns, and social policy
are among the many foci of community health research and
evaluation,

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 CHARACTERISTICS OF COMMUNITY HEALTH NURSING ……. Cont.

(7) it uses principles of organizational theory;

Community health nursing uses principles from organizational
theory to provide effective administration of health care
services. Public health has long been defined as the protection
and improvement of community health through organized
community efforts.
As community health nurses carefully assess group and
community needs, establish priorities, and plan, implement,
and evaluate services, they are using public health
management and organizational principles.

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 CHARACTERISTICS OF COMMUNITY HEALTH NURSING ……. Cont.

(8) it involves interprofessional collaboration..

Community health nurses must work in cooperation with
other team members, coordinating services and addressing
the needs of population groups. This interprofessional
collaboration among health care workers, other
professionals, and clients is essential for establishing effective
services and programs.

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